Sleep disturbances are extremely common in people with PTSD. There is evidence that sleep disturbances make PTSD symptoms worse. Thus, it is important to identify and treat sleep disturbance in everyone with PTSD.
Nightmares are a common cause of disturbed sleep. They tend to disrupt the Rapid Eye Movement (REM) stage of sleep, which is when dreaming takes place. Often, the nightmare wakens the sleeper with all of the problems that follow.
There is a medication called prazosin that has been shown to be beneficial for many patients with PTSD who suffer from nightmares. Often, these nightmares have a similar theme that involves elements of the experience that led to the PTSD. It works by blocking nerve receptors within a structure in the brainstem named the nucleus coeruleus, which means "blue spot" because of its color.
The locus coeruleus is involved with the brain's response to stress. It is the structure in the brain where adrenalin is made. Adrenalin is the stress hormone that prepares us for dealing with danger. Excitation of that bundle of nerves results in arousal, attention, emotional responses, irritability, and disrupted REM sleep. It also causes the release of cortisone chemicals that affects the immune system among other things. Adrenalin is also produced by the adrenal glands on top of the kidneys. This adrenalin is released into the blood stream to assist in preparation for danger.
Evidently, PTSD creates a hypersensitivity that causes the locus coeruleus to produce excessive adrenalin. This results in sleep disturbance from nightmares. By blocking excess stimulation of the locus coeruleus, the production of excess adrenalin is prevented thus protecting the patient from nightmare-associated sleep disturbance.
Prazosin was originally developed to treat high blood pressure. Later, drugs like it were found to benefit men with symptoms from an enlarged prostate. Use of this drug for nightmares is a more recent development. It can only be obtained by prescription. It is also used in some cases to treat anxiety and even panic attacks.
Like all medications, it has side effects. It dilates blood vessels, which is how it lowers blood pressure. Unfortunately, this effect can result in fainting, especially during the first 24 hours when it is first used.
There is also a non-medication treatment for PTSD-associated nightmares. It is called Dream Rehearsal in which the patient rehearses elements of the nightmare but with a positive outcome. This treatment is usually provided by a psychologist or other therapist. This form of treatment can be combined with prazosin.
Peter M. Hartmann, MD
Adult Psychiatry
